Coral snake bites (Micrurus spp.) in Brazil: a review of literature reports.

CONTEXT: In the Americas, the main representatives of the family Elapidae are coral snakes of the genus Micrurus, of which 33 species are in Brazil. They are the smallest cause of venomous snakebite in Brazil. We analyzed literature reports of coral snake bites in Brazil from 1867 to 2014, and provide a brief review of case series and reports of coral snake bites in the Americas in general. METHODS: Only reports with clinical descriptions of envenomation were included. The variables recorded included identification of the offending snake, patient's age, sex, bite site, clinical manifestations, treatment, including antivenom and anticholinesterase drugs, and general evolution of the cases. 30 published reports describing bites caused by Micrurus spp. in Brazil were identified and involved 194 distinct cases. Since no information on the clinical manifestations was available in 44 cases, the analysis was restricted to 25 reports (150 cases). RESULTS: Most patients were from southern (61.3%; primarily Santa Catarina state, 60%) and southeastern (20%) Brazil and were male (70.7%), with a median age of 27 years (interquartile interval = 18 to 40 years). The offending snakes were described in 59 cases (M. corallinus 36, M. frontalis 12, M. lemniscatus 5, M. hemprichi 2, M. filiformis 1, M. ibiboboca 1, M. spixii 1 and M. surinamensis 1); in 22 cases only the genus (Micrurus spp.) was reported. Of the 143 cases in which the bite site was recorded, most involved the hands (46.2%) and feet (26.6%). The main clinical features were local numbness/paresthesia (52.7%), local pain (48%), palpebral ptosis (33.3%), dizziness (26.7%), blurred vision (20.7%), weakness (20%), slight local edema (16%), erythema (16%), dysphagia (14.7%), dyspnea (11.3%), inability to walk (10.7%), myalgia (9.3%), salivation (8%) and respiratory failure (4.3%). Fang marks were described in 47.3% of cases and 14% of bites were classified as asymptomatic. A slight increase in total blood creatine kinase was reported in 3 children, suggesting mild myotoxicity. Therapeutic procedures included coral snake antivenom (77.3%), anticholinesterase drugs (6%), and mechanical ventilation (3.3%). Two patients reported in 1933 developed paralysis/respiratory failure and died 6 h and 17 h post-bite. Four more deaths probably caused by coral snakes were reported (2 in 1867, 1 in 1959, 1 in 1962), but no clinical information was available. DISCUSSION: Neuromuscular blockade was the hallmark of systemic envenomation by Micrurus spp., with signs of myasthenia such as weakness and ptosis that may evolve to paralysis and respiratory failure. Local features, mainly numbness/paresthesia and pain, were frequently reported, with the pain being intense in some cases. Although myotoxicity has been detected in experimental studies with Micrurus spp. venoms, few human reports described laboratory findings compatible with myotoxicity. CONCLUSION: Most coral snake bites reported in Brazil were caused by M. corallinus and M. frontalis, with several patients showing signs of acute myasthenia. Serious complications such as paralysis with respiratory failure were observed but comparatively rare. The deaths occurred where respiratory support (mechanical ventilation) was unavailable when needed.

First report of hepatic hematoma after presumed Bothrops envenomation.

In Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.

First report of hepatic hematoma after presumed Bothrops envenomation

ABSTRACTIn Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.

Significance of alanine aminotransferase levels in patients admitted for cocaine intoxication.

BACKGROUND: Experimental studies in animal models and case reports in humans have described the hepatotoxic potential of cocaine. However, there are few data regarding the clinical and laboratory characteristics of patients admitted for cocaine intoxication, particularly regarding the status of the liver enzymes. GOAL: To investigate the significance of alanine aminotransferase (ALT) levels in individuals hospitalized for acute cocaine intoxication. METHODS: Retrospective study with standardized chart review that included patients admitted between January 2003 and December 2010. Bivariate analyses were used to investigate factors associated with ALT above the upper tertile according to gender. Cases of marked ALT elevation were described in detail. RESULTS: Ninety-three patients were included (79% men, mean age of 27.73±9.97 y). ALT above the upper tertile was associated with higher aspartate aminotransferase (AST), creatine phosphokinase, creatinine, and international normalized ratio. Higher levels of ALT were also related to acute renal failure and death. Five subjects had severe ALT elevation during follow-up and all had evidence of hepatocellular dysfunction (jaundice, prolonged prothrombin time with or without hepatic encephalopathy), rhabdomyolysis, and acute renal failure. AST/ALT ratio <2 was present in 2 subjects with severe ALT elevation at admission, but AST/ALT ratio >2 was observed in 3 cases with evidence of progression to acute liver injury. CONCLUSIONS: In acute cocaine intoxication, higher ALT levels were associated with evidence of muscle damage, progression to acute renal failure, and death. Severe liver damage was observed in 5% of the sample and was associated with rhabdomyolysis and renal failure in all cases.

Farmacovigilância no Brasil

O vídeo apresenta a entrevista com a farmacêutica Maria Eugênia Cury, chefe do Núcleo de Gestão do Sistema Nacional de Notificação em Vigilância Sanitária (NUVIG/Anvisa), sobre a criação e a estruturação da farmacovigilância no Brasil. Apresenta uma breve descrição e histórico, as ações realizadas pela farmacovigilância e o papel do Estado e da ANVISA nesta atribuição.

Intoxicações por medicamentos

Módulo 5, unidade 3 do curso Gestão da assistência farmacêutica. O vídeo apresenta o tema das intoxicações por medicamentos e suas consequências para a saúde pública no Brasil, com destaque para a atuação dos Centros de Informação e Assistência Toxicológica (CIAT).

Intoxicações por medicamentos

O vídeo apresenta o tema das intoxicações por medicamentos e suas consequências para a saúde pública no Brasil, com destaque para a atuação dos Centros de Informação e Assistência Toxicológica (CIAT).

Farmacovigilância

O conteúdo trata da Farmacovigilância e apresenta conhecimentos, métodos e ferramentas que podem subsidiar as ações de farmacovigilância no cotidiano dos serviços. Apresenta endereços eletrônicos de Agências ou autoridades reguladoras na área de medicamentos, e Publicações, Boletins, Guias, Revistas e Manuais na área de farmacovigilância no mundo, auxiliando na obtenção de informações sobre os medicamentos. Discute, também, o papel do profissional nas ações relacionadas à farmacovigilância.

Gestão da Assistência Farmacêutica: módulo 4: unidade 6: farmacovigilância

O conteúdo trata da Farmacovigilância e apresenta conhecimentos, métodos e ferramentas que podem subsidiar as ações de farmacovigilância no cotidiano dos serviços. Apresenta endereços eletrônicos de Agências ou autoridades reguladoras na área de medicamentos, e Publicações, Boletins, Guias, Revistas e Manuais na área de farmacovigilância no mundo, auxiliando na obtenção de informações sobre os medicamentos. Discute, também, o papel do profissional nas ações relacionadas à farmacovigilância.

Farmacovigilância no Brasil

O vídeo apresenta a entrevista com a farmacêutica Maria Eugênia Cury, atual chefe do Núcleo de Gestão do Sistema Nacional de Notificação em Vigilância Sanitária (NUVIG/Anvisa), sobre a criação e a estruturação da farmacovigilância no Brasil.

Intoxicações por medicamentos

O vídeo apresenta o tema das intoxições por medicamentos e suas consequências para a saúde pública no Brasil, com destaque para a atuação dos Centros de Informação e Assistência Toxicológica (CIAT).

Clinical and epidemiological study of 27 poisonings caused by ingesting puffer fish (Tetrodontidae) in the states of Santa Catarina and Bahia, Brazil.

Puffer fish can be poisonous due to the presence of the potent neurotoxins such as Tetrodotoxin (TTX) and Saxitoxin (STX) found in its tissues. The authors report 27 human poisonings from ingestion of puffer fish in patients treated at Toxicology Centers in the states of Santa Catarina and Bahia, Brazil, between 1984 and January 2009. Poisonings were classified as moderate (52%) and severe (33%), two deaths were observed. Early diagnosis is very important to ensure respiratory support.

Clinical and epidemiological study of 27 poisonings caused by ingesting puffer fish (Tetrodontidae) in the states of Santa Catarina and Bahia, Brazil / Estudo clinico-epidemiológico de 27 envenenamentos causados pela ingestão de baiacus (Tetrodontidae) nos estados de Santa Catarina e Bahia, Brasil

Puffer fish can be poisonous due to the presence of the potent neurotoxins such as Tetrodotoxin (TTX) and Saxitoxin (STX) found in its tissues. The authors report 27 human poisonings from ingestion of puffer fish in patients treated at Toxicology Centers in the states of Santa Catarina and Bahia, Brazil, between 1984 and January 2009. Poisonings were classified as moderate (52 percent) and severe (33 percent), two deaths were observed. Early diagnosis is very important to ensure respiratory support.

Os baiacus ou peixes-bola podem ser venenosos devido à presença em seus tecidos corporais de Tetrodotoxina e/ou Saxitoxina, ambas potentes neurotoxinas. Os autores relatam 27 envenenamentos por ingestão da carne de baiacus. Os pacientes foram atendidos nos Centros de Toxicologia de Santa Catarina e da Bahia de 1984 a 2009. Os acidentes foram classificados em moderados (52 por cento) e graves (33 por cento), havendo dois óbitos. O diagnóstico precoce é fundamental no sentido de garantir suporte ventilatório aos pacientes.

Tentativo suicídio com agentes tóxicos: analise estatística dos dados do CIT/SC (1994 a 2006) / Suicide attemps with toxic agents: statistical analysis from de CIT/ SC data ( 1994- 2006)

It has been recognized that toxic agents, such as prescribed medicines, pesticides or any other substances, are used as “weapons” to attempt suicide. The objective of this study is know statistic features about the toxic agents used in the suicide attempts recorded at the Toxicological Information Center of Santa Catarina (CIT-SC). Therefore, a descriptive study of quantitative data was used to access a historical serie (1994 a 2006). From 75.755 cases of intoxication registered, there were analyzed 10,310 cases of suicide attempt by toxic agents. In these 13 years, CITSC has been logging progressively more cases of suicide attempt, and that was largely due to acute single exposure, resulting in clinical intoxication. Medicines were responsible for 56 per cent of cases, followed by pesticides, with 34 per cent, and by industrial and domestic chemicals products. There was not proved an increase in the rate of suicide attempt, but there was a real growth in the use of medications for this objective, which may be due to multiple causes, from cultural to flaws in the prescription and dispensing. It suggested that policies of control of xenobiotics, especially about medicines and pesticides, need improvement of the rules and more accuracy in the use.

Atualmente se reconhece que os agentes tóxicos sejam eles medicamentos prescritos, praguicidas ou qualquer outra substância, são utilizados como “armas” para tentativas de suicídio. O objetivo deste estudo é conhecer dados estatísticos dos agentes tóxicos usados nas tentativas de suicídio registradas no Centro de Informações Toxicológicas de Santa Catarina (CIT/SC). Para isso,utilizou-se um estudo descritivo de dados quantitativos de uma série histórica (1994 a 2006). De um total de 75.755 casos de intoxicação registrados no período, foram analisados os 10.310 casos de tentativas de suicídio por agentes tóxicos. Nestes 13 anos, o CIT/SC vem registrando sendo grande parte decorrente de exposição aguda única, resultando em quadro de intoxicação. Os medicamentos foram responsáveis por 56 por cent dos casos, seguidos pelos praguicidas, com 34 por cento, e por produtos químicos industriais e domissanitários. Não foi comprovado um aumento nas taxas de tentativas de suicídio, mas observou-se um real crescimento no uso de medicamentos para esta finalidade, cujas causas podem ser múltiplas, desde culturais até falhas na prescrição e dispensação. Sugerindo assim, que as políticas de controle dos xenobióticos, em especial os praguicidas e medicamentos, requerem aprimoramento de normas e mais rigor no uso prático.

Blood coagulation and fibrinolytic factors in 105 patients with hemorrhagic syndrome caused by accidental contact with Lonomia obliqua caterpillar in Santa Catarina, southern Brazil.

Haemostatic disorders caused by Lonomia obliqua caterpillars has reached epidemic proportions in southern Brazil. Here we evaluated coagulation and fibrinolysis in 105 patients after accidental contact with Lonomia obliqua caterpillars. Global coagulation tests were prolonged in most cases and patients were divided into 3 groups according to fibrinogen (Fg) level: 1.5 g/l (group C). There was a significant reduction of factors V, XIII, VIII and prekallikrein in group A, with no change in factors X, II and von Willebrand factor. Thrombin-antithrombin and prothrombin F1+2 were elevated in most patients. Antithrombin and protein S were not changed whereas protein C levels were reduced in group A. Plasminogen and alfa2-antiplasmin levels were significantly reduced in group A and D-Dimer levels were extremely high in all groups, showing that fibrinolysis had been activated, possibly secondary to fibrin production. Levels of t-PA were normal and PAI-1 was mildly elevated in group A. The platelet count remained above 150 x 109 platelets/ml in 97% of cases. In summary, our results suggest that Lonomia obliqua envenoming is characterized by a consumption coagulopathy and secondary fibrinolysis.

Avaliaçäo dos parâmetros de coagulaçäo e fibrinólise no plasma de pacientes acidentados por contato com lagartas da espécie Lonomia obliqua / Blood coagulation and fibrinolytic factors in 105 patients with hemorrhagic syndrome caused by accidental contact with Lonomia obliqua caterpillar in Santa Catarina, southern Brazil

Objetivo: Avaliar o comportamento dos parâmetros da coagulaçao e da fibrinólise no plasma de pacientes que tiveram contato com lagartas da espécie Lonomia obliqua. Métodos: Foram avaliados 105 pacientes entre duas e 150 horas pós contato com Lonomia obliqua, selecionados dentre um total de 201 pacientes atendidos com história de contato com lagarta no período de dezembro de 1998 a junho de 2000 no hospital Regional de Chapecó, SC. As amostras de sangue foram coletadas, no momento da chegada do paciente no hospital, em tubos contendo uma mistura de citrato de sódio e soro antilonômico (SALon) ou citrato de sódio, aprotinina e soro antilonomico (SALon). O TC, TP, TTPA e TT foram analisados em plasma fresco, imediatamente após a coleta da amostra. Os parâmetros especiais da coagulaçao e da fibrinólise foram analisados em plasma congelado no nitrogênio líquido, através de ensaios coagulométricos, cromogênicos e de enzima imunoensaio. Resultados: Os teste globais foram muito prolongados na maioria dos casos. O fibrinogênio foi o fator mais reduzido, apresentando-se alterado em 87 por cento dos pacientes e a sua medida foi a mais sensível para avaliar alteraçoes da hemostasia. Os pacientes foram, entao, divididos em três grupos de acordo com os níveis de fibrinogênio: Grupo A: Fg <_ 0,5 g/I (N=73); Grupo B: Fg entre 0,51 a 1,5 g/I (N=15) e Grupo C: Fg > 1,5 g/I (N=17). Foi detectada uma reduçao significante do FV, FXIII e PK no grupo A. O FVI11 foi pouco reduzido e o F11, X XII e FvW nao foram alterados. Os marcadores da ativaçao da coagulaçao, tais como, TAT e F1+2 estavam elevados na maioria dos pacientes. Surpreendentemente, a AT nao foi reduzida, apesar dos níveis elevadíssimos de TAT. A PS igualmente nao foi reduzida no entanto, os níveis de atividade da PC apresentaram reduçao significante. Os níveis de atividade do Plasminogênio...(au)

Ocorrência de intoxicação por ingestão de baicu / Occurrence of Intoxication from eating globfish

Os peixes considerados venenosos ou sarcotóxicos possuem toxinas na pele, músculos, víceras e gônodas. Dentre as 80 espécies existentes no Brasil, em Santa Catarina destaca-se o baiacu, cuja toxina (tetrodotoxina) apresenta propriedades neurotôxicas. Os acidentes causados pela ingestão de baiacu tem sido descrita ocasionalmente no estado de Santa Catarina....

Ocorrência de acidentes provocados por peixes peçonhentos / The occurrence of accidents caused by poisonous fish species

O acidente provocado por peixes peçonhentos ou acantóxicos denomina-se ictismo. Peixe peçonhento ou acantóxico é aquele que possui glândulas epidérmicas de veneno associadas com esporões em nanadeiras e cauda. Há poucos estudos sobre os casos de ictismo no Brasil, embora existam aproximadamente 130 espécies de peixes que provocam acidentes entre os pescadores, mergulhadores e banhitas...

Acidentes provocados por Physalia sp (caravelas): 238 casos relatados no litoral catarinense / Accidents caused by physalia sp (man of war): 238 cases reported in the catarinense seashore

A espécie Physalia sp é o tipo de caravela mais freqüente e de maior atividade tóxica do litoral brasileiro, causando acidentes por contatos, com sintomatologia de dor, eritema, prurido, contrações musculares, vômitos, podendo ocorrer também hemólise, insuficiência renal e choque anafilático. Analisou-se a frequencia destes acidentes, notificados ao centro de Informações Toxicológicas (CIT/SC) no período de 1984 a 1996....